This week, there are new recommendations for chlamydia and gonorrhea screening for young women, a secret shopper study found that young men may have a harder time buying EC over the counter, and Kansas seizes sex toys.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

New STD Screening Suggestions for Young Women

The U.S. Preventive Services Task Force, an independent panel of experts that advises the Department of Health and Human Services, released new recommendations this week related to sexual health.

First, it announced that all sexually active women ages 24 and younger should be screened for chlamydia and gonorrhea; women older than 24 should be screen if they have any risk factors including a new sexual partner, multiple sexual partners, or unprotected sex. Chlamydia and gonorrhea are two of the most common sexually transmitted infections (STIs) in this country. The Centers for Disease Control and Prevention estimates that 2.86 million cases of chlamydia and 820,000 case of gonorrhea occur in the United States each year. Both of these infections are caused by bacteria and as such can be cured with antibiotics but both are often asymptomatic and therefore go undetected. If left untreated, these conditions can lead to pelvic inflammatory disease, which can in turn lead to infertility. Routine screening can catch infections before they cause any long-term health problems.

Though the task force considered issuing new recommendations on screening tests for men, it concluded that doing so was not necessary.

The task force did make another important recommendation around sexual health, however. It suggested intensive behavioral counseling for all sexually active teens as well as for those adults at risk of contracting an STI. Kirsten Bibbins-Domingo, the co-vice chair of the task force explained to Healthline that this recommendation is based on research showing how effective counseling can be. She pointed to one study that found two hours of counseling could reduce a person’s risk by 60 percent, and a half hour could do so by 40 percent. She said, “This is an important recommendation with regard to prevention. It says that moderate to high intensity counseling about condom use, mutual monogamy, and abstinence, are actually effective in preventing STDs. This isn’t just a casual conversation; it’s at least 30 minutes of counseling.”

Such counseling would include education about the STIs and how they are transmitted, assessment of the individual’s own risk, explanations of how to use a condom, and strategies for communicating with partners.

Young Men Turned Away Trying to Buy EC

Researchers at Columbia University’s Mailman School of Public Health wanted to see if young men really had access to over-the-counter emergency contraception (EC) pills. To find out, they sent mystery shoppers (trained young men ages 19, 25, and 28) to 158 pharmacies in certain New York City areas, including Washington Heights, the Bronx, and the Upper East Side.

Though the results were just published in the Journal of Contraception, the experiment took place in 2012. Today, there are no age restrictions on who can buy EC pills, but at the time they were only available over the counter to people 17 and older. There was never any gender restriction on who could buy the pills, but the study’s lead author, David Bell, told Reuters that some of his young male patients would tell him they were turned away when they tried to buy it for their female partners.

The mystery shopper study found that most pharmacies they went to (128) would sell EC to a young man, but some made it difficult. Thirty pharmacies did not sell the product to the young men. Of these, eight said it was not in stock. The remaining 22 insisted that the young men come back either with their female partner or with their partner’s ID.

Bell told Reuters that young men might have a harder time accessing EC places outside of New York. And in small towns where there may only be one pharmacy, being turned away could be even more harmful.

Kansas Holds a Sex Toy Auction

If you happen to be in Kansas City, Kansas, on September 29, you could get a great deal on some sex toys and help the state make up for lost tax revenue at the same time. The state seized the sex toy merchandise—thousands of adult items from vibrators to handcuffs—from five adult stores across the state that had the same owner. United Outlets LLC, doing business as Bang (naturally), owes the state $163,986 after failing to pay sales, income, and withholding tax.

Some lawmakers expressed outrage that the state would be involved in such an untoward enterprise. State Sen. Anthony Hensley (D-Topeka), said in a press release, “[Gov. Sam] Brownback is so desperate to fill the massive hole in the state budget caused by his reckless income tax cuts that the state of Kansas is now in the porn business.”

But Jeannine Koranda, a spokesperson for the state Department of Revenue, pointed out that the state isn’t actually selling the merchandise: “The property was released back to the owner, who then contracted with the auction company to sell the items, and then that money will be used to pay the taxes.”

Gov. Brownback’s office also issued a response to Hensley’s criticism, saying, “While we do not agree with the type of business involved here, it was nonetheless a legal business that was closed due to failure to pay taxes.”

For those of us less interested in Kansas politics and more interested in getting our hands on discount merchandise (which is all in its original, unopened packaging), the contents of the warehouse will also be available through an online auction run by Equip-Bid Auctions.

The rise of antibiotic-resistant bacteria is a looming public health crisis. Last week, the White House simultaneously released a national strategy, a report, and an executive order from the president that takes aim at this issue.

Antibiotic-resistant bacteria, White House officials charge, poses not just a health threat, but an economic and national security threat as well.

People for more than a century have relied on antibiotics to cure everything from earaches and strep throat to gonorrhea and syphilis. But bacteria are constantly evolving and existing medications—especially if they are overused—will not be effective indefinitely.

The PCAST report explains that “responsible stewardship of antibiotics requires identifying the microbe responsible for disease (ideally with rapid and inexpensive diagnostics); administering the most effective antibiotic at the appropriate dose, route, and time; and discontinuing antibiotic therapy when it is no longer needed.”

It goes on to say that scientists need increased and improved surveillance to help better understand how resistant infections emerge and are transmitted.

Even with these advances, PCAST warns, “it is critical to develop new antibiotics, diagnostics, vaccines, and other interventions at a rate that outpaces the emergence of resistant microbes. A robust antibiotic pipeline is essential for creating new antibiotics to replace those being steadily lost to antibiotic resistance.”

Antibiotics—which are typically taken for no more than two weeks—are less profitable than drugs designed to treat chronic conditions that are often taken for many years. Pharmaceutical companies do not have the financial incentive necessary to put their research and development dollars into this pipeline.

This is among the problems that the National Strategy and the PCAST report aim to solve. The strategy lays out five goals, including curbing the overuse of antibiotics, encouraging the development of new drugs, and boosting the advancement of diagnostics tests that can immediately determine whether bacteria are drug resistant.

Though the strategy does not mention funding, the accompanying report suggests that reaching these goals will require doubling the government’s investment in fighting drug resistance from $450 million to $900 million per year. The president’s executive order does not mention funding either, but it does create a task force to look into the problem and mandates that the task force develop a five-year action plan by February 2015.

As a first step, the White House announced the launch of a $20 million prize for the development of rapid, point-of-care, diagnostic test for health-care providers to use to identify highly resistant bacterial infections.

Advocates for sexual health are particular interested in these new announcements because of the fear that an outbreak of antibiotic resistant gonorrhea is imminent.

As RH Reality Checkreported last year, the CDC has called neisseria gonorrhoeae, the bacteria that causes gonorrhea, an “urgent threat.” Between 1940 and 2007, this bacteria became resistant to whole classes of drugs: sulfanilamides, penicillins, tetracyclines, and fluoroquinolones. Today, only cephalosporins remain effective to treat the estimated 800,000 cases of gonorrhea in this country each year.

The CDC now recommends ceftriaxone plus either azithromycin or doxycycline as first-line treatment for gonorrhea. In 2011, there were 3,280 cases of gonorrhea that had reduced susceptibility to ceftriaxone and 2,460 that had reduced susceptibility to azithromycin. Other countries are seeing cephalosporin-resistant cases.

Most recently, four cases of gonorrhea resistant to ceftriaxone were reported in Sweden.

Lynn Barclay, president of the American Sexual Health Association, told RH Reality Check that her organization was excited about the attention being paid to this issue: “Resistance to antibiotics, which is fueled in part by over-use of these common medications, is an enormous challenge to public health that increases costs and worsens patient outcomes. We’re down to one antibiotic to treat gonorrhea, that’s not just unacceptable, it’s actually scary. This plan, which seeks to facilitate more appropriate use of antibiotics while encouraging expanded pipelines of new products, is some of the best news we’ve heard in years. For my money it can’t be implemented quickly enough.”

William Smith, executive director of the National Coalition of STD Directors, which has asked for increased government investment in fighting antibiotic-resistant gonorrhea, is also excited about this plan.

“We’re really supportive of what the president is trying to do,” he said in an interview with RH Reality Check. “We think the goals are smart—particularly, the increased focus on creating diagnostic tests for resistance.”

Smith said that the problem is mammoth and more resources are needed.

“We need larger incentives for diagnostic companies to develop tests and larger investments in the development of new drugs,” he said. “But we also need a significant investment in the infrastructure of public health departments that have been subjected to repeated budget cuts. If we expect public health readiness when an antibiotic resistant outbreak hits, we need big dollar investment in those workers on the front lines.”

This week, a new study presents evidence that the parasite that causes trich might lead to prostate cancer, a new list shows the best and worst states for STIs, a Gallup poll shows the most support ever for same-sex marriage, and gay rights activist Harvey Milk is honored with a stamp.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Could Prostate Cancer Be Sexually Transmitted?

There is precedence for the idea that sexually transmitted infections (STIs) can cause cancers: We know that two strains of human papillomavirus (HPV) cause 70 percent of all cervical cancers and that the virus is likely responsible for the recent rise in head, neck, and throat cancers as well. Now researchers are suggesting that an STI may also be responsible for cases of prostate cancer.

Researchers at the University of California infected human prostate cancer cells with the common STI trichomoniasis (known as trich). They found that the parasite that causes trich produced a protein that promotes the growth of both benign and cancerous prostate cells.

There is other research to suggest a connection between prostate cancer and trich; a 2009 Harvard study found that a quarter of men with prostate cancer had trich, and those who did had more advanced tumors.

Even when put together, however, these studies are not enough to confirm that prostate cancer is indeed caused by trich. In fact, Nicola Smith, health information officer at Cancer Research UK, told the BBC that previous evidence in patients failed to show a clear link between prostate cancer and this common STI.

More research is clearly needed, as 233,000 men in the United States are expected to be diagnosed with prostate cancer this year, and there are an estimated seven to eight million cases of trich annually. It is important to remember that unlike HPV, trich can be cured with antibiotics. Moreover, consistent and correct use of condoms can prevent infection in the first place. If confirmed, these results could suggest that some prostate cancers would be preventable.

Which States Have the Most STIs?

We know that while there is an STI epidemic in this country, incidence and prevalence of infections are not evenly distributed throughout the 50 states. Some states and regions have far worse track records than others. The good folks at Nerd Wallet recently culled the data and put it all together in an easy-to-read list of the best and worst states when it comes to STIs.

To calculate the ranking, they looked at the prevalence of chlamydia, gonorrhea, and syphilis. All three of these STIs are reportable to the Centers for Disease Control and Prevention (CDC), which means we have a clear picture of how many cases of each disease have been diagnosed in each state. The states were ranked according to prevalence of each STI, and then the rankings were added together to get the overall score. (In the case of a tie, the final ranking was made based on the state’s chlamydia rate, because that is the most frequently reported STI.) Though this should be obvious—since we are looking at it from the point of view of humans and not pathogens—the “best” states are those with the fewest cases of STIs.

The five best states are: West Virginia (48th for chlamydia, 41st for gonorrhea, 49th for syphilis); Maine (49th for chlamydia, 44th for gonorrhea, 43rd for syphilis); Vermont (46th for chlamydia, 46th for gonorrhea, 44th for syphilis); Utah (47th for chlamydia, 45th for gonorrhea, 42nd for syphilis; Wyoming (37th for chlamydia, 50th for gonorrhea, 46th for syphilis); and Montana (35th for chlamydia, 48th for gonorrhea, 50th for syphilis).

The ten worst states are: North Carolina (tenth for chlamydia, sixth for gonorrhea, 24th for syphilis); New York (11th for chlamydia, 16th for gonorrhea, seventh for syphilis); Texas (13th for chlamydia, 13th for gonorrhea, sixth for syphilis); Illinois (ninth for chlamydia, tenth for gonorrhea, eighth for syphilis); and Arkansas (seventh for chlamydia, seventh for gonorrhea, ninth for syphilis).

This list provides some good information for state lawmakers, who can and should be doing a better job ensuring education about sexual health and providing sexually active people of all ages access to condoms and other contraceptive methods needed to prevent unintended pregnancy and STIs.

Support for Same-Sex Marriage at All-Time High

This week, in the latest of a series of decisions paving the way for same-sex marriage across the country, a judge in Pennsylvania struck down that state’s ban. Republican Gov. Tom Corbett, who is running for re-election, says his administration will not challenge the decision. While that would seem unheard of a few years ago, other Republican governors—including Chris Christie in New Jersey, Susanna Martinez in New Mexico, and Brian Sandoval in Nevada—have also decided to stop fighting same-sex marriage. A new Gallup poll suggests this is a wise move, as support has reached an all-time high.

Gallup has been asking the same question since 1996: “Do you think that same-sex couples should be or should not be recognized as valid, with the same rights as traditional marriages?” The first time the question was asked, 68 percent said no and only 27 percent said yes. In 1999 the needle moved a tiny bit, with 62 percent saying no and 35 percent saying yes. In 2004, 55 percent said no and 42 percent said yes. Though the number changed incrementally from there, by 2011 there was a cross-over, with more Americans supporting same-sex marriage than opposing it.

The newest poll, conducted in May, shows the mirror image of what was going on just one decade ago: Now, 55 percent of Americans believe that same-sex marriages should be valid, and only 42 percent said they should not be.

Harvey Milk Stamp Released

Last week, on what would have been his 84th birthday, the U.S. Postal Service released a stamp featuring a picture of Harvey Milk, one of the first openly gay elected officials in the country. Milk, an outspoken advocate of gay rights who had been elected as a city supervisor in San Francisco, was assassinated along with the city’s mayor in November of 1978. In a White House ceremony dedicating the stamp to Milk, Postmaster General Ronal Stroman said, “Harvey Milk joins other civil rights pioneers who have been honored with stamps including Martin Luther King Jr. and Caesar Chavez.”

Anne Kronenberg, who served as campaign manager during Milk’s run for office and is the co-founder of the Harvey Milk Foundation, joked at the ceremony, “During our campaign we didn’t have enough money for postage. So Harvey, here you are today on a United States Postage stamp and I say this is a wonderful thing because you will be there forever.”

When patients in California are diagnosed with chlamydia or gonorrhea, doctors can send them home with medication not only for themselves, but also for their partners. It’s a practice called expedited partner therapy, and it’s legal in 35 states as well as the city of Baltimore.

And now, thanks to Bill 20-343, the Expedited Partner Therapy Act of 2013, you can add Washington, D.C., to that list. Introduced by D.C. city council members David Grosso, Anita Bonds, and Tommy Wells and co-sponsored by six others, the bill passed its final reading last Tuesday. It is now awaiting Mayor Vincent Gray’s expected signature and the completion of a 30-day Congressional review process. The city council expects the bill to become law in April or May.

“It’s an important issue,” said Grosso, a former board member at Planned Parenthood Metro Washington. “We have to get control over our STD issues in the District.”

The reality of those issues, according to the D.C. Committee on Health’s report on the bill, is dire. From 2010 to 2011, chlamydia and gonorrhea diagnoses rose 18 and 22 percent, respectively. Seventy-one percent of chlamydia cases and 62 percent of gonorrhea cases occur in people between ages 15 and 24. Executive witness Michael Kharfen, an interim senior deputy director for the D.C. Department of Health’s HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), noted two points in his testimony: that prescribing medication without first examining patients is acceptable in cases of emergencies and epidemics, and that the rate of sexually transmitted infections (STIs) in D.C. is reason to approve the use of expedited partner therapy (EPT).

The Centers for Disease Control and Prevention’s (CDC) 2013 “Threat Report” lists chlamydia and gonorrhea as the two most common bacterial infections in the United States. Both can cause complications with pregnancy, increase the chance of infertility, and make those who are infected moresusceptible to HIV infection. Yet their treatment often requires only a single dose of medication or, at most, a week-long cycle.“These diseases are very easy to cure,” said Stephanie Arnold Pang, director of policy and communications at the National Coalition of STD Directors (NCSD). “The drugs come with very low side effects. This is just another tool in the toolbox.”

It would be optimal if everyone with chlamydia or gonorrhea saw a health-care provider first-hand (this is referred to as an index patient) and received treatment from that visit (called a provider-assisted referral). But the reality is that this isn’t always possible. The CDC started recommending the use of EPT in 2005 because many individuals, particularly those from low-income communities, which are most affected by chlamydia and gonorrhea, face limited resources that keep them out of doctors’ offices; jobs with inflexible hours, lack of access to transportation, and insufficient or noinsurance are common barriers to doctor visits. While EPT is not the best way to treat chlamydia and gonorrhea, the alternative—those who cannot or will not go to a health-care provider remaining untreated—is far worse.

EPT is also beneficial for index patients because treating infected partners is crucial to preventing reinfection. Put more plainly, if two people have sex and one has an STI, treating only one of the two partners makes for a job half-finished. The D.C. bill painted a clear picture of the reinfection problem, noting that “the 12-month reinfection rate of chlamydia among adolescents and young women [in D.C.] is as high as 26%, often due to untreated male sexual partners.” In addition, “nearly one in five [D.C.] teens diagnosed with chlamydia or gonorrhea had a prior diagnosis within 12 months and nearly one third had a prior diagnosis in the preceding two years.”

“The evidence is utterly clear that [EPT] is effective in preventing reinfection,” NCSD Executive Director Bill Smith told RH Reality Check. “If we have a patient come in, and they test positive for chlamydia and go home and have sex with the same partner, they’re going to get reinfected. We can drive those infection rates down significantly by providing EPT.”

In 2001, California became the first state to authorize EPT. An NCSD fact sheet notes that nearly half of California’s doctors and nurse practitioners report using EPT. It also shows that the state has an 80 percent partner treatment rate with EPT—“the same partner treatment rate for those who agreed to bring their partners with them to the clinic”—and that EPT can reduce the estimated $850 million that is spent annually to fight chlamydia and gonorrhea by curbing infection rates and, in turn, reliance on public services to treat STIs.

“EPT is highly effective,” said Heidi Bauer, chief of the California Department of Public Health’s Center for Infectious Diseases STD Control Branch. “Several research studies, including randomized clinical trials, have demonstrated that [it] is safe and as effective as other partner management strategies in facilitating partner notification and reducing recurrent infection among index cases. We have had no calls regarding adverse reactions.”

Despite EPT’s success, its ease of use among the states where it is legal varies. In Georgia, for example, prescriptions that are faxed or emailed have to include a patient’s name and address—a requirement that can be difficult to meet for patients with no direct contact with doctors. And in Massachusetts, dispensing prescription medications requires “the physical act of delivery of a drug to an ultimate user.” In some states, doctors send patients home with doses of medication for their partners, while in others they send prescriptions. (This also variesbased on whether the provider is a public health center or a private practice.)

Of the remaining 15 states, the CDC lists nine where EPT is “potentially allowable,” which often means that there is conflicting regulation information. On one hand, prescriptions might not require a name, which would allow a doctor to practice EPT. But on the other hand, they may be limited to one per patient, which would prevent it. The D.C. report cites testimony from doctors who “candidly explained they have bypassed the District’s lack of EPT laws by writing prescriptions to patients that contained two doses and prepared to justify it as a preventative measure ‘just in case the patient got sick and vomited’ while taking the first dose.” But without explicit permission—the CDC’s benchmark for listing a state as having permissible EPT—doctors who use EPT are at risk.

“Physicians’ hands are tied without this legislation,” said Annette Mercatante, a board-certified family practice physician and the medical director at Michigan’s St. Claire County Health Department. “A lot of physicians opt to do EPT rather than treat the same patient four or five times in a row. I think most physicians do the right thing, but it’d be nice to have the legal health code back us up on it.”

Kentucky, Michigan, and West Virginia, three of the six states where EPT is outright prohibited, are on the verge of making progress: In Kentucky and Michigan, EPT bills have passed in the house and are awaiting votes in the senate, and in West Virginia a bill is in the House Judiciary Committee. Each faces the slow but steady process of illuminating the EPT issue and clarifying misinformation.

“I realized [what EPT was] because I started going to conferences where the NCSD spoke about it,” said Rep. Mary Lou Marzian (D-Louisville), the sponsor of Kentucky’s EPT bill. “It was something I had been unaware of, and I’ve been here 20 years.”Marzianwent on to acknowledge the political struggle characteristic of any issue relating tosex or prescription drugs—let alone both at once. “Sometimes legislators are so backward,” she said, “that anything that has to do with sex they sort of giggle like it’s kindergarten.”

In Michigan, Sen. Jim Marleau (R-Lake Orion), chair of the senate’s Health Policy Committee, has not brought the EPT bill to a vote because the health department in his home county—Oakland, an influential Detroit suburb—has raised concerns that treating gonorrhea with EPT could lead to the bacteria becoming drug-resistant. But in its 2013 “Threat Report,” the CDC stated that the best way to stave off such a scenario is to keep gonorrhea infection rates low; EPT, the report said, is a key means of doing so.

Mercatante is optimistic that Michigan’s bill will pass. “Most health departments are solidly in favor of this because they realize the benefit of treatment outweighs the risk of gonorrhea resistance,” she said. “Our job is to treat diseases, so whatever we could do to improve treatment compliance, we’d be supportive of a policy like that.”

Before the D.C. bill passed, Yvette Alexander, a council member and chair of the health committee, was wary that once the District started using EPT, authorities would be unable to track the number of positive STI diagnoses in D.C. According to health committee Director Rayna Smith, Alexander’s concerns were quelled with an addition requiring providers to report prescriptions for both index patients and partners to the D.C. Department of Health.

Its recent passage is not all that puts D.C.’s bill in the EPT legislative forefront. Bill 20-343 allows EPT for not only chlamydia and gonorrhea, but also trichomoniasis, an STI with a rising infection rate and dangerous symptoms that is, like chlamydia and gonorrhea, easily cured. While the CDC has not yet approved EPT for treating trichomoniasis, states like Vermont and Wisconsin have added similar provisions that allow it.

D.C.’s legalization of EPT is a progressive step for a medical practice whose day is long overdue. The bill received overwhelming support and no opposition throughout its vetting process, and once Alexander’s concerns were addressed it passed through council vote easily. With wheels turning in West Virginia, and EPT being potentially allowable in Maryland and Virginia, D.C.’s new law could be a step in the right direction for not only the District but also the region.

“It was more than time for the District to take this important step,” said Christina Henderson, Grosso’s deputy chief of staff, “and join these other states in what has been proven to be a good thing for the public health of residents.”

The Centers for Disease Control and Prevention has released sexually transmitted disease surveillance data for 2012, and the news is not good: Cases of chlamydia, gonorrhea, and syphilis all continued to rise.

Last Wednesday, the Centers for Disease Control and Prevention (CDC) released sexually transmitted disease (STD) surveillance data for 2012, and the news is not good. Cases of chlamydia, gonorrhea, and syphilis—the three disease that must be reported to the CDC—all continued to rise. In fact, there were over 1.4 million cases of chlamydia reported to the CDC in 2012, the most ever. There were also 334,826 cases of gonorrhea and 15,667 cases of primary and secondary syphilis.

When looking at the rates, syphilis is the most alarming, as there were five cases per 100,000 individuals, which represents an 11 percent increase over the previous year. Gonorrhea rates increased 4 percent from the year before, to 107 cases per 100,000 individuals.

Rates for chlamydia were more stable, increasing only 0.7 percent since 2011. Still, there were 456 cases per 100,000 individuals.

To understand the scope of this epidemic, however, we have to remember that this data represents reported cases, but many cases of these STDs go undiagnosed and unreported. We also have to remember that other common STDs, such as trichomoniasis or human papillomavirus (HPV), are not reportable and, therefore, not included in the new data.

The data also makes it clear that some populations—specifically, men who have sex with men (MSM) and young people—are significantly more affected than others. For example, the CDC notes that men who have sex with men account for 75 percent of all primary and secondary syphilis cases. Though syphilis can be treated, if not caught it can lead to serious health conditions such as blindness or stroke. Moreover, infection with syphilis increases the risk of individuals both acquiring and transmitting HIV. In fact, data suggests that as many as 40 percent of MSM with syphilis are also infected with HIV.

More than half of all cases of both chlamydia and gonorrhea are seen in young people between the ages of 15 and 24. The CDC reports that 24 percent of chlamydia cases occur in young people ages 15 to 19, and 34 percent in those ages 20 to 24. Similarly, 30 percent of gonorrhea cases occur in young people ages 15 to 19, and 39 percent in 20- to 24-year-olds. These are both curable STDs; however, if left untreated they can cause long-term health problems. In particular, the CDC estimates that undiagnosed STDs cause 24,000 women to become infertile each year. In addition, as RH Reality Checkhas been reporting over the last few years, gonorrhea has become resistant to many antibiotics used to treat it in the past, and there are now only a few drugs that work to cure some strains of this bacteria. Public health experts are concerned that without the introduction of new antibiotics, gonorrhea may become difficult, if not impossible, to cure in the future.

“The ever-increasing rates of sexually transmitted diseases continue to threaten the health and well-being of millions of Americans, particularly youth and men who have sex with men,” said William Smith, executive director of the National Coalition of STD Directors, in a statement. “The long-term consequences of these diseases impact the health of the individual, burden our larger health care system, and drastically hinder our continued fight against HIV and AIDS.”

“Simply put, STD public health programs do not have enough resources to address all the serious problems that face them. As a result, thousands, if not millions, of Americans at risk for STDs are not able to be reached, which has long-term human and economic costs,” said Smith. “STD programs desperately need additional funding to address these rising rates and meet our STD epidemics effectively.”

In addition to increasing the resources available to STD programs, there are steps that should be encouragedat the individual level to thwart the epidemic. First and foremost, sexually active individuals need to be reminded of the risks of STDs as well as measures they can take to reduce risk—most importantly, condom use. Research has shown that condoms are highly effective at preventing all three of the STDs included in this data.

Regular screenings also can help keep individuals from unknowingly passing the infection on to others, while preventing their own long-term conditions. The CDC recommends that all women age 25 and under get screened for chlamydia annually, and that MSM and women with risk factors, such as a new partner or multiple partners, be screened for chlamydia, gonorrhea, syphilis, hepatitis B, and HIV each year. MSM who have multiple or anonymous partners should be screened at three- to six-month intervals.

]]>http://rhrealitycheck.org/article/2014/01/14/report-sexually-transmitted-disease-cases-increased-2012/feed/0When It Comes to STDs and Relationships, Skip the Website and Talk to Each Otherhttp://rhrealitycheck.org/article/2013/10/30/when-it-comes-to-stds-and-relationships-skip-the-website-and-talk-to-each-other/?utm_source=rss&utm_medium=rss&utm_campaign=when-it-comes-to-stds-and-relationships-skip-the-website-and-talk-to-each-other
http://rhrealitycheck.org/article/2013/10/30/when-it-comes-to-stds-and-relationships-skip-the-website-and-talk-to-each-other/#commentsWed, 30 Oct 2013 20:38:05 +0000http://rhrealitycheck.org/?p=27131

A new website asks members to sign up for frequent STD testing and lets them share their results with other members confidentially. Encouraging STD testing is a good thing, but the site has major flaws. And when it comes to STDs, I can’t help but wonder if we would do best to leave the digital world in our pocket and just talk.

The last time I was single was 1995. It might not sound like that long ago, but from a technology standpoint it was practically the Stone Age; google was still just a number, Mark Zuckerberg was in elementary school, and only birds tweeted. The most advanced technology available to me was a beeper and an answering machine. So I might not know all that much about dating in the era of social networking and smart phones, but nonetheless the newest entry into this market strikes me as inefficient and a little creepy.

Earlier this week, a new site launched that mixes social networking with sexually transmitted disease (STD) testing, with a splash of online dating thrown in for fun. The site is called MyLuhu.com, and the model is a little complicated (as evidence by 31 frequently asked questions on the site). But it boils down to this: A single person can join Luhu for $92 upfront and then $10 a month. The site has partnered with Quest Diagnostic, a nationwide chain of laboratories, which will provide members with quarterly tests for HIV, hepatitis C, and syphilis. Members can choose to be tested for other STDs as well. If the tests come back negative, members receive a badge that proves they are healthy. They can share their test results with other members or put the badge on their Facebook page or other social media sites. If the tests come back positive, they get a call from a counselor; they get no badge and their results are not kept on the site. If members let their testing slip and don’t have current results to share, their badge turns to amber.

The main goal of the site is to give single people a way to confidentially and reliably share test results. The site is HIPPA-compliant and has no paperwork. The results are stored electronically and are “locked” so they are only available to the member and anyone the member chooses to share them with. The shared results come with the member’s first name and birth date as a way to verify that the person is being honest, and the FAQs point out that the laboratory requires identification at the time of the test so results can’t be faked. Shared results are only available to the recipient for 24 hours.

There is an element of the site’s underlying philosophy here that I really like. The founders say they want to make STD testing a more regular part of everyone’s lives, take away some of the stigma and awkwardness, and reward those who are invested in their sexual health. In fact, a member can make a profile on Luhu and search for others who have done the same, thus being sure they are finding someone who also values good sexual health. That’s great. I applaud efforts to increase testing and believe making sexual health a point of pride for individuals is a great goal.

Unfortunately, I think the site fails in its execution, and I have real doubts about its widespread appeal.

First, I don’t believe it actually succeeds at its method of proof that someone is disease-free, because it relies on a quarterly check for three STDs, and not even those that are the most common. Members earn a green badge for being free of HIV, syphilis, and hepatitis C; the founders of the site say they chose to focus on these because they are the most life-changing and life-threatening. I am not sure these should be the criteria by which one ranks which STDs to test for, nor am I sure that I agree with the site’s assessment of which diseases are the most life-changing or even most life-threatening.

Syphilis, for example, made their list, but only an estimated 45 people died from syphilis in 2011. Human papillomavirus (HPV) did not make the site’s list, which makes sense in one way because most people who get it don’t even know they have it and clear the infection within one or two years without any intervention. But if you look at it from another angle, HPV causes over 20,000 cases of cancer each year, which can be both life-changing and life-threatening. Herpes, which is far more common than the three STDs that are routinely tested on Luhu, is left off the list in part because “it is a disease that is, overall, not deadly, and can be suppressed with medication.” Again, I take issue with the criteria—at this point few STDs are deadly, and even HIV can be suppressed with medication for decades.

Moreover, I have a sinking suspicion that these criteria were chosen based on ease of testing. In fact, the FAQs note that herpes and HPV are both left off the mandatory list in part because testing is difficult. There is a blood test for herpes, but it returns many false positives. And it is better to diagnose herpes with an exam during an outbreak; this can’t be done quarterly in a lab. Testing for HPV in women involves pap smears and other tests, which take cells from the cervix, something that also cannot be done in a lab. And, as of now, there are no tests for HPV in men.

Chlamydia and gonorrhea, however, can be tested for using a urine analysis, which can be done in a lab, so I’m less sure of why the founders chose not to include these in their badge-earning criteria. After all, these are among the most commonly reported and easily transmitted STDs, and are often asymptomatic, which means testing is the only way individuals will find out they are infected. The Centers for Disease Control and Prevention estimates that there are 2.86 million new cases of chlamydia and 820,000 new cases of gonorrhea each year, compared to 55,400 cases of syphilis and 41,400 cases of HIV. Sure, if they are caught they can be cured with antibiotics without causing any long-term health issues, but if they are left undetected and untreated they can lead to pelvic inflammatory diseases and then infertility. While this might not be deadly, it is certainly life-changing for many couples. To me, these diseases seem like perfect candidates for frequent testing and badges.

The “clean” badge has another problem as well: It’s a snapshot in time. A quarterly test is great, but if I am about to sleep with someone in May, the fact that he was free of three STDs at the end of March doesn’t mean very much if he engaged in a lot of risky behavior in between. I worry that between covering only a few of the STDs out there and showing results that may no longer be relevant, the badges will actually present people with a false sense of security or, worse, an excuse not to use condoms with their new partner.

To be clear, I’m not suggesting more frequent testing. The founders of Luhu claim monthly testing as an ideal, but that seems excessive, unless you are in a very high-risk pool. Instead, I think I like the way we did it in the old days before any of us had an app for that: We talked. We asked each other about our risks. We asked if we’d been tested. We got tested again and shared the results. And, until we knew each other well enough to trust that the other was disease-free and not continuing to engage in any risky behaviors, we took universal precautions and used a condom every time.

I’m all for technology. I check Facebook constantly and can’t believe I ever watched TV without being able to pause it. But when it comes to STDs, I can’t help but wonder if we would do best to leave the digital world in our pocket and just talk.

This week, a novel approach to infertility is announced, a new vaginal ring might be able to protect from HIV transmission, and the answer to preventing drug-resistant gonorrhea may be in our own immune systems.

Researchers in Japan announced on Monday that a new method to help women suffering from one form of infertility has resulted in one healthy baby boy and another pregnancy. The women suffered from a condition known as primary ovarian insufficiency in which the ovaries prematurely stop releasing eggs. About one percent of women of reproductive age suffer from this condition, they are often thrown into early menopause and cannot become pregnant. Because they are no longer producing mature eggs of their own, their only option for infertility treatments has been to use a donor egg.

This new experimental procedure seems a bit like science fiction: doctors remove ovaries from the woman, cut them into small cubes, treat the cubes with egg-stimulating drugs, treat the woman with similar drugs, and then put the cubes back into the woman’s abdomen to wait for the eggs to mature.

To picture this, it helps to remember that ovaries are about the size and shape of a large Greek olive. Inside, they have thousands of microscopic little chambers called follicles. Each follicle holds an unmatured egg (or oocyte). A woman is born with all the eggs she will ever have but they are suspended in this immature state. In a working ovary, one of these oocytes typically matures every other month (the two ovaries usually take turns) leading to ovulation and then either pregnancy or menstruation.

Of the 27 women who underwent this new treatment for the study in Japan, five produced mature eggs. Like in other in vitro procedures, a woman’s eggs were then fertilized with her partner’s sperm and the resulting embryo (if one developed) was transplanted into her uterus.

The study’s author, Dr. Kazuhiro Kawamura, told the press, “I always felt emotional anxiety [about the treatment approach] … but when I saw the healthy baby, my anxiety turned to delight. The couple and I hugged each other in tears.”

It will likely be years before this procedure is widely available.

New Vaginal Ring May Prevent HIV Infection

A study in the Proceedings of the National Academy of Sciences has shown that a new vaginal ring developed by researchers at Northwestern University in Illinois may be able to protect women from HIV transmission. The ring is actually a polymer tube filled with the powdered form of the antiretroviral drug Tenofovir. It is designed to be worn continuously for 30 days. When the ring gets moist, which would happen naturally during most acts of intercourse, the polymer expands and some of the drug is released into the vagina.

Tenofovir is a nucleoside reverse transcriptase inhibitor (NRTI), which works to reduce the amount of HIV in a person’s blood. Studies have found that oral Tenofovir can also dramatically reduce a person’s risk of acquiring HIV. In 2012, the Food and Drug Administration approved the use of a combination drug containing Tenofovir. As part of a prevention method known as PrEP (pre-exposure prophylaxis), the drug can be taken once a day by adult men who do not have HIV but are at high risk because of their sexual behavior or intravenous drug use.

Though Tenofovir is usually taken orally, the researchers who invented the vaginal ring, which is known as TDF-IVR, believe that by delivering the drug topically right to where it is needed, they can use a lower dosage. Moreover, women would not have to remember to take a pill each day, nor would they have to remember to insert a ring right before intercourse. Public health experts have been wanting a prevention method that women across the world can use without necessarily having to inform a partner who would object.

The researcher recently tested TDF-IVR in non-human primates and found that it was able to block 100 percent of the simian version of HIV. Human trials will likely start next month.

Currently, there are also trials taking place to see if a gel form of Tenofovir can prevent HIV transmission when applied rectally prior to anal sex.

Researchers Boost Immune Systems to Fight Gonorrhea Reinfection

As RH Reality Check reported, the Centers for Disease Control and Prevention (CDC) recently named antibiotic-resistant gonorrhea an urgent threat, noting that almost 30 percent of the current 800,000 cases that occur each year are resistant to one or more of the drugs used to treat the infection. One reason that the bacteria that causes gonorrhea has been so resilient and adaptable is the high rates of reinfection among individuals. New research, published in the Journal of Infectious Diseases, suggests that the answer to preventing reinfection and ultimately antibiotic-resistance may be boosting the immune system’s response to the bacteria.

Michael Russell, a microbiologist at the State University of New York, Buffalo has been studying gonorrhea for 20 years. In a press release, he explains his belief that the bacteria that cause gonorrhea is able to re-infect individuals easily because it alters a person’s immune system and prevents them from developing long-term resistance to the bacteria the way they would to other germs.

Our immune systems generally have two responses to illness: the innate or immediate response that lets us fight off a current infection and the adaptive response that develops antibodies to help better fight later infections. Russell found that people with gonorrhea infections had a high rate of a chemical in the body known as IL-10 and believes that this suppresses the adaptive response. He and a colleague then devised a way to use a different chemical, IL-12, to counteract IL-10.

So far, the treatment has only been used in laboratory mice (who were first infected with gonorrhea) but it has been very effective. Those mice who were given IL-12 responded better to antibiotics and were less likely to get re-infected when re-exposed than the control group of mice. Russell believes that IL-12 prevents the immune system from being “tricked” into suppressing its own adaptive immune response.

As the CDC notes, the best way to hold back the tide of antibiotic resistant gonorrhea is to prevent gonorrhea infections in the first place. Preventing re-infections, obviously, is also important.

On Monday, the Centers for Disease Control and Prevention (CDC) released a new report about drug-resistant bacteria, which categorizes pathogens by threat-level: urgent, serious, or concerning. Not surprisingly, Neisseria gonorrhoeae, the bacteria that causes gonorrhea, was named an “urgent threat.” As RH Reality Checkhas been reporting for over a year, evidence suggests that if nothing is done, the United States will soon see cases of antibiotic-resistant gonorrhea.

The CDC estimates that there are more than 800,000 new cases of gonorrhea in the United States annually, making it one of the most common sexually transmitted infections (STIs). The infection may cause itching, burning, discharge, or pain during urination, but often has no symptoms. If left untreated, however, it can cause pelvic inflammatory disease and lead to infertility in both men and women. Gonorrhea is treatable with antibiotics, but Neisseria gonorrhoeaehassteadily developed resistance to entire classes of antibiotics. Between 1940 and 2007, it became resistant to sulfanilamides, penicillins, tetracyclines, and fluoroquinolones. Today, cephalosporins remain effective, but in the United States its susceptibility is declining, and other countries are seeing cephalosporin-resistant cases.

The CDC now recommends ceftriaxone plus either azithromycin or doxycycline as first-line treatment for gonorrhea. In 2011, there were 3,280 cases of gonorrhea that had reduced susceptibility to ceftriaxone and 2,460 that had reduced susceptibility to azithromycin. The CDC report notes that “cephalosporin resistance, especially ceftriaxone resistance, would greatly limit treatment options and could cripple gonorrhea control efforts.” It goes on to say:

If cephalosporin-resistant N. gonorrhoeae becomes widespread, the public health impact during a 10-year period is estimated to be 75,000 additional cases of pelvic inflammatory disease (a major cause of infertility), 15,000 cases of epididymitis, and 222 additional HIV infections, because HIV is transmitted more readily when someone is co-infected with gonorrhea. In addition, the estimated direct medical costs would total $235 million.

Public health advocates have been warning of this kind of outbreak for some time and have asked Congress to invest additional money into testing, tracking, and treatment. In April, advocates addressed Congress, asking for $54 million in emergency funding to improve the nation’s STD public health infrastructure. William Smith, president of the National Coalition of STD Directors (NCSD), one of the organizations behind the request, said in a statement Monday, “So while some would say that we cannot afford additional investments in gonorrhea prevention now, this report, again, makes one thing clear: we can invest $54 million dollars now to better prepare those on the front lines of drug-resistant gonorrhea, or we can pay hundreds of millions of dollars later when drug-resistant gonorrhea is widespread.”

Smith’s organization would like to see this money used to train private providers in proper diagnosis and treatment protocols, increase both lab and surveillance capabilities across the country, train additional disease intervention specialists (professionals who work with patients to identify partners and then work to contact and treat those partners), fund evidenced-based programs such as expedited partner therapy, which allows health-care providers to write prescriptions for patients’ partners without a visit, and create public education campaigns. NCSD is also calling on its industry partners to create new tests for gonorrhea—similar to ones that already exist for tuberculosis—that can determine resistance right away so providers know what drugs to use.

In addition to these efforts to improve testing and treatment for gonorrhea, it is also important that the heath industry and government work together to create new antibiotics. In releasing the report, which addresses a number of other drug-resistant bacteria as well, CDC Director Thomas Frieden warned of a post-antibiotic era in which nothing we have now works and nothing new has been invented. He said if the current trend continues, “the medicine cabinet may be empty for patients who need them in the coming months or years.”

This new report sounds the alarm and suggests four core actions for dealing with these threats: preventing infections, tracking resistance patterns, improving how antibiotics are prescribed and used (to prevent misuse and overuse), and developing new antibiotics and diagnostics tests.

On Monday, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) announced the results of a promising new treatment for gonorrhea. In a clinical trial researchers combined existing antibiotics into two new drug regimens—injectable gentamicin in combination with oral azithromycin and oral gemifloxacin in combination with oral azithromycin. Both were able to successfully treat gonorrhea infections.

Once thought of as an eminently treatable infection, public health experts have been sounding alarm bells over the past few years as the bacterium that causes gonorrhea has become resistant to more and more of our existing drugs. As I explained in a piece for RH Reality Check last year, as early as the 1940s, gonorrhea was resistant to sulfanilamides, and by the 1980s, penicillins and tetracyclines no longer worked. Later, in 2007, the CDC stopped recommending the use of fluoroquinolones (the class of drugs that includes Cipro). Today, the only class of antibiotics that remains effective is cephalosporins, but the bacterium’s susceptibility to these drugs is rapidly declining.

The findings from the new trial provide hope that existing drugs in new combinations will work. In fact, the trial found that the injectable gentamicin/oral azithromycin combination cured 100 percent of genital gonorrhea infections, the oral gemifloxacin/oral azithromycin cured 99.5 percent of genital cases, and both combinations cured 100 percent of infections of the throat and rectum. Researchers noted, however, that many patients in the trial complained of side effects, especially gastrointestinal issues.

While promising, the new trial does not change the CDC’s current treatment guidelines. CDC still recommends injectable ceftriaxone, in combination with either oral azithromycin or oral doxycycline. However, the studied combinations may be used in cases of severe allergy to the other drugs and will be considered as the CDC continues to evaluate and update its treatment guidelines.

Advocates agree that this is an important interim step, but caution that combinations of existing drugs may not be the long-term solution we need. Dr. Gail Bolan, director of the CDC’s Division of STD Prevention, said in a statement, “These trial results are an exciting step in the right direction in the fight against drug-resistant gonorrhea. But patients need more oral options with fewer side effects. It is imperative that researchers and pharmaceutical companies prioritize research to continue to identify new, effective, better-tolerated drugs and drug combinations.”

William Smith, president of the National Coalition of STD Directors, agreed, explaining in a statement, “[W]e must remember these are existing antibiotics and gonorrhea has shown a remarkable ability to develop resistance quickly to all of our existing families of antibiotics. So while these treatments may buy us some additional time, we need investments in the creation of new antibiotics immediately.”

Smith and others also point out that preventing a widespread outbreak of antibiotic-resistant gonorrhea will take more than new treatment options. As RH Reality Checkhas reported in the past, the system with which we screen, test, and treat sexually transmitted infections (STIs) is underfunded, outdated, and stretched beyond its limits.

There are approximately 800,000 cases of gonorrhea in the United States each year. Many people do not have any symptoms. Others may feel itching, burning, discharge, or pain during urination. If left untreated, gonorrhea can cause pelvic inflammatory disease and lead to infertility in both men and women. It is important that sexually active individuals get screened for this and other STIs. In addition, condoms are highly effective in preventing gonorrhea when used consistently and correctly.

Public health advocates headed to Congress last week to ask for $53.5 million to help state and local health departments prepare for the impending appearance of antibiotic-resistant gonorrhea in the United States.

Gonorrhea is one of the most common sexually transmitted infections (STIs), with over 700,000 cases in the United States each year. The infection may cause itching, burning, discharge, or pain during urination, but often has no symptoms. If left untreated, however, it can cause pelvic inflammatory disease and lead to infertility in both men and women. Gonorrhea, once known as “the clap,” has long been thought of as minor by many because it can be treated with antibiotics.

However, as I explained in a piece for RH Reality Check last year, Neisseria gonorrhoeae, the official name for this pesky bacterium,hassteadily developed resistance to entire classes of antibiotics. As early as the 1940s, it was resistant to sulfanilamides, by the 1980s penicillins and tetracyclines no longer worked, and in 2007 the Centers for Disease Control and Prevention (CDC) stopped recommending the use of fluoroquinolones (the class of drugs that includes Cipro, which we may all remember as the thing to stockpile in case of an anthrax attack). Today, the only class of antibiotics that remains effective is cephalosporins, but the bacterium’s susceptibility to these drugs is rapidly declining.

Last summer, the CDC changed its treatment guidelines for gonorrhea because the bug is becoming resistant to oral ceftriaxone, which had been the recommended drug. Now, the CDC suggests that infection be treated with injectable ceftriaxone in combination with one of two oral antibiotics—doxycycline or azithromycin. The goal of this change is to preserve the effectiveness of ceftriaxone, because it is the last drug that works and there are no others in the pipeline.

The first U.S. case of gonorrhea that’s highly resistant to current antibiotics was discovered recently in Hawaii. Similar cases have been seen in other countries, including Norway and Japan. William Smith, the executive director of the National Coalition of STD Directors (NCSD) and one of the advocates who addressed Congress last week, told the Washington Times that this case was “worrisome.” He went on to say, “Experts agree that it’s not a matter of if gonorrhea-resistance will hit, it’s a matter of when it will hit.”

Deborah Arrindell, vice president of health policy at the American Sexual Health Association (ASHA), put it more dramatically, telling RH Reality Check, “Gonorrhea is a fighter. This is one of the most common infectious diseases, and it has an uncanny ability to resist antibiotics. It’s just a matter of time before there’s nothing left behind the pharmacy counter to treat it.”

Both ASHA and NCSD worked with Congress last year on the GAIN (Generating Antibiotic Incentives Now) Act, which was passed as part of the most recent Food and Drug Administration (FDA) User Fee Law. Under this act, the FDA will begin to work with drug companies to encourage the research and development of new antibiotics to combat gonorrhea and other emerging “super bugs.” While advocates agree that this is a good first step, it’s not enough, which is why ASHA, NCSD, and others went back to the Hill to ask for emergency funding. Smith explained the need for this money to RH Reality Check: “Due to drastic budget cuts, health departments across the country have had to furlough or layoff staff and as result have constricted the scope of their work over the past several years—to the point of being bare bones. The public health infrastructure simply can’t respond to this imminent threat without some new money coming in.”

The request to Congress specifies that the money is needed in five areas: diagnosis and treatment, surveillance and lab capacity, disease intervention specialists, evidence-based interventions, and education and awareness.

As I explained in my article last year, one of the problems with gonorrhea is how we currently diagnosis it. Most STD clinics use something called a Nucleic Acid Amplification Test (NAAT), which is very cheap and also tests for chlamydia. However, because it relies on urine, it can only detect genital infections and those of the urethra or cervix, but not those in other areas that bacteria can infect, such as the throat or anus. Moreover, it does not provide information on the strain of the bacteria, so a clinician has no way of knowing if a patient has a resistant strain; that would require culturing, which many clinics are no longer set up to do. This has repercussions for treatment—without this information, clinicians presume the prescription they gave worked, and if they see the same patient again they’re likely to assume it’s a new infection. It also has repercussions for tracking trends and following the super bug if and when it gets here. That’s where the money for surveillance and lab capacity will help.

As for disease intervention specialists, they are health department employees who work with patients to identify sexual partners who might have been infected. They then contact those partners to offer testing and treatment. Smith says that this work is crucial to “break the chain of disease transmission and protect the community’s health.” The money would also be used to scale up evidence-based interventions such as Expedited Partner Therapy (EPT), which also helps to break the chain by allowing physicians to prescribe medications to partners of infected patients without having to examine the partners. These measures are all part of the Cephalosporin-Resistant Gonorrhea Public Health Response Plan published by the CDC last summer.

Advocates argue that the plan can’t be put into place without additional funding, and that such funding would be a wise investment. Arrindell pointed out, “Untreated gonorrhea has high human costs in pain and suffering—it facilitates transmission of HIV and can cause problems that lead to infertility. But it also carries a high economic burden for our nation. The CDC estimates that in a mere seven years, drug-resistant gonorrhea could add about $780 million to our over-burdened health-care system. An investment of $53 million today is much cheaper than dealing with the clap run amuck.”

Smith also stressed that this isn’t like HIV, which we don’t know how to cure: “If we aren’t prepared when antibiotic-resistant gonorrhea hits, we will have a serious public health crisis our hands, with only our own lack of attention and investment to blame.”